Journal of Pain Research
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Relationship of depression in participants with
nonspecific acute or subacute low back pain and
no-pain by age distribution
Cesar Calvo-Lobo 1
Juan Manuel Vilar Fernndez 2
Ricardo
Becerro-de-Bengoa-Vallejo 3
Marta Elena Losa-Iglesias 4
David Rodrguez-Sanz 5
Patricia Palomo Lpez 6
Daniel Lpez Lpez 7
1
Physical Therapy Department,
Motion in Brains Research Group,
Instituto de Neurociencias y Ciencias
del Movimiento, Centro Superior
de Estudios Universitarios La Salle,
Universidad Autnoma de Madrid,
Madrid; 2Modeling, Optimization and
Statistical Inference Research Group,
Universidade da Corua, A Corua;
3
School of Nursing, Physiotherapy and
Podiatry, Universidad Complutense
de Madrid, Madrid; 4Faculty of Health
Sciences, Universidad Rey Juan Carlos,
Madrid; 5Physical Therapy & Health
Sciences Research Group, Facultad de
Ciencias de la Salud, el Ejercicio y el
Deporte, Universidad Europea de Madrid,
Madrid; 6University Center of Plasencia,
Universidad de Extremadura, Badajoz;
7
Research, Health and Podiatry Unit,
Department of Health Sciences, Faculty
of Nursing and Podiatry, Universidade da
Corua, ACorua, Spain
Correspondence: Cesar Calvo-Lobo
Physical Therapy Department, Motion
in Brains Research Group, Instituto de
Neurociencias y Ciencias del Movimiento,
Centro Superior de Estudios Universitarios
La Salle, Universidad Autnoma de Madrid,
CSEULS-UAM. C/La Salle, 10,
Madrid 28023, Spain
Tel +34 91 740 1980
Fax +34 91 357 1730
Email cecalvo@lasallecampus.es
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http://dx.doi.org/10.2147/JPR.S122255
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ORIGINAL RESEARCH
This article was published in the following Dove Press journal:
Journal of Pain Research
11 January 2017
Number of times this article has been viewed
Background and purpose: Nonspecific low back pain (LBP) is the most prevalent musculo-
skeletal condition in various age ranges and is associated with depression. The aim of this study
was to determine the Beck Depression Inventory (BDI) scores in participants with nonspecific
LBP and no-pain by age distribution.
Methods: A casecontrol study was carried out following the Strengthening the Reporting of
Observational Studies in Epidemiology criteria. A sample of 332 participants, divided into the
following age categories: 1924 (n=11), 2539 (n=66), 4064 (n=90), 6579 (n=124), and 80
(n=41) years was recruited from domiciliary visits and an outpatient clinic. The BDI scores
were self-reported in participants with nonspecific acute or subacute (3 months) LBP (n=166)
and no-pain (n=166).
Results: The BDI scores, mean standard deviation, showed statistically significant differ-
ences (p<0.001) between participants with nonspecific acute or subacute LBP (9.5906.370)
and no-pain (5.8255.113). Significantly higher BDI scores were obtained from participants
with nonspecific acute and subacute LBP in those aged 4064 years (p<0.001; 9.1406.074
vs 4.7003.777) and 6579 years (p<0.001; 10.6726.126 vs 6.2105.052). Differences were
not significant in younger patients aged 1924 (p=0.494; 5.0002.646 vs 8.2507.498), 2539
(p=0.138; 5.4405.245 vs 3.6344.397), and in those aged 80 years (p=0.094; 13.6256.1331
vs 10.4405.591).
Conclusion: Participants with nonspecific acute and subacute LBP present higher BDI depres-
sion scores, influenced by age distribution. Specifically, patients in the age range from 40 to
80years with LBP could require more psychological care in addition to any medical or physical
therapy. Nevertheless, physical factors, different outcomes, and larger sample size should be
considered in future studies.
Keywords: depression, low back pain, musculoskeletal diseases, age distribution
Introduction
Worldwide, the Global Burden of Disease Study 2013 established low back pain (LBP)
as the first musculoskeletal disorder and the fourth leading condition, after ischemic
heart disease, lower respiratory infections, and cerebrovascular disease that causes
disability for the life years.1 LBP is a common condition, which is referred to primary
care and physical therapy units.2 Furthermore, 20 to 40% of the general population
has suffered low back pain during the previous month.3 The LBP estimated incidence
rate includes 80% of the active population worldwide.4 Its prevalence has increased
during recent years in Spain as the population ages and psychological distress increases
(anxiety or depression), among other factors.5
Journal of Pain Research 2017:10 129135 129
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Calvo-Lobo et al
Pain intensity, functional impairment, and health-related
quality of life do not correlate with lumbar degenerative
radiological changes.6 The variability of temporary disability
duration in patients with LBP and depression, among other
conditions, produces a strong impact in the Spanish Public
Health. Furthermore, a multifactorial influence, such as
medical-biological or socioeconomic factors, may determine
the disability of these pathologies.7 Indeed, beliefs about the
nature of pain and personal ability influence both physical and
mental health outcomes in LBP patients. Organic pain beliefs
are more deeply related to disability and depression than psy-
chological pain beliefs.8 Therefore, the fear-avoidance model
is associated with depressive symptoms in a multiple-target
approach to understand LBP mechanisms.9 Participants with
LBP should be screened and treated for depression to reduce
disability and limit pain-related activities.10
The negative prognostic factors for disability in par-
ticipants with nonspecific subacute pain are involvement
of several body regions, older age, baseline disability, and
longer duration. Furthermore, anxiety and depression show
limited evidence of association with disability in patients
with subacute pain.11 Nevertheless, a recent systematic review
suggested that the prognosis in acute and subacute LBP (pain
of <12 weeks duration) may be influenced by depression.12
Furthermore, specific outcome and psychometric tools are
necessary in the aging process associated with patients with
LBP. Older adults are more likely to experience a major
disabling LBP incident compared to younger individuals.13
Therefore, this highlights the importance to examine the
relationship between age and depression in LBP patients.
Health practitioners should consider depressive symp-
toms at the first consultation to improve acute and subacute
LBP treatment.14 Approximately 72% of total costs per patient
with subacute LBP in primary care are related to depression
and emotional distress.15
To date, the depression scores in the Spanish population
have not been compared according to LBP status and age
categories. The aim of this study was to determine the Beck
Depression Inventory (BDI) scores in a sample of partici-
pants with nonspecific acute or subacute LBP and no-pain
by age distribution.
Methods
Design
A cross-sectional case-control study was carried out from
January 2015 to January 2016. The Strengthening the Report-
ing of Observational Studies in Epidemiology guidelines
were applied.16
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Ethical considerations
The study was approved by the Clinical Research Ethics
Committee of the Universidade da Corua (Spain; number
CE 21/2016). Informed written consent was obtained from
all volunteers before their inclusion in the research study.
Furthermore, the Helsinki Declaration and ethical standards
in human experimentation were adhered to at all times.
Sample
A sample of 332 subjects was divided into the following
age categories: 1924 (n=11), 2539 (n=66), 4064 (n=90),
6579 (n=124), and 80 (n=41) years. Participants were
recruited from domiciliary visits (for healthy participants)
and from Carmasalud Clinical and Research Center (for LBP
participants). A consecutive sampling method was used to
select the participants in the study.
The inclusion criteria were: Spanish subjects, aged
>18years, and normal (no pain) participants or participants
with nonspecific acute or subacute LBP.11,12,14,15,17 A nonspecific
pain condition was defined as soreness of mechanical origin.17
Furthermore, LBP was considered as pain predominantly
located in the posterior trunk region, between the subcostal
line and the upper part of the iliac bones.1215 Finally, acute
and subacute LBP were categorized as pain of <12weeks
duration,14,15 in keeping with The Quebec Task Force on Spinal
Disorders LBP categorization, as acute (<24 weeks), subacute
(up to 12 weeks), and chronic (>12weeks).17,18
The exclusion criteria were: fractures; pain radiating to
lower limbs with intensity equal to or greater than LBP; pain
located in other body regions different from LBP; neurologi-
cal deficit in lower limbs; active systemic neoplastic, infec-
tious, or autoimmune conditions; prior surgery in the spinal
column; inability to understand the research instructions;
and patients of other nationalities (non-Spanish).19 In addi-
tion, participants with nonspecific chronic LBP (>3months)
were excluded.11,12,14,15
Procedure
First, sociodemographic data (age, gender, height, weight,
and body mass index [BMI]) were collected prior to the
questionnaire. Second, the BDI scores were self-reported
in participants with acute or subacute LBP (n=166) and no-
pain (n=166).11,12,14,15,19 The BDI questionnaire comprises 21
items. Each item is scored from 0 to 3 points (total range from
0to63). The BDI score categories are, no depression (09),
mild depression (1016), moderate depression (1729),
and severe depression (3063). This questionnaire presents
a coefficient alpha of 0.86 for psychiatric patients and 0.81
Journal of Pain Research 2017:10
Dovepress Depression in low back pain by age distribution

for nonpsychiatric subjects, and distinguishes the depression
subtypes, and depression from anxiety.20 The BDI is a valid
and reliable tool in the Spanish population and can be used
cross-culturally in Europe.21
Statistical analysis
A descriptive analysis of the variables was carried out. The
mean, standard deviation (SD), and range values were cal-
culated for the age, sex, weight, height, BMI, and BDI. Fur-
thermore, these analyses were performed both overall and by
age distribution (1924, 2539, 4064, 6579, and 80years)
for both groups (with LBP and no-pain). Independent t-tests
for each sample were used to assess significance.
In addition, the relationship of LBP and age distribution
to the BDI depression scores was assessed by two methods.
First, a test of equality of means of the BDI for the LBP
versus no-pain groups was performed. Second, an analysis
of variance (ANOVA) model was used with two factors (LBP
and age distribution) and interaction. The dependent variable
was the BDI of each participant and the two independent
variables were the LBP presence (LBP or no-pain group)
as well as the age ranges (1924, 2539, 4064, 6579, and
80 years). Statistical analyses were carried out using the
statistical package SPSS 22.0 (IBM Corp, Armonk, NY,
USA). A confidence interval (CI) of 99% and a p<0.01 were
considered statistically significant for differences between
the mean BDI scores in participants with LBP and no-pain.
Results
A sample of 119 men (35.8%) and 213 women (64.2%) com-
pleted the study. Table 1 demonstrates the BDI depression
scores and sociodemographic characteristics by age distri-

Table 1 BDI depression scores and sociodemographic characteristics by age distribution of participants with LBP and no-pain
Sociodemographic and Total group mean SD LBP mean SD (range), No-pain mean SD p-value (ta)
BDI data (range), N=322 N=166 (range), N=166 LBP vs no-pain
Age (years) 57.8919.27 (1999) 58.0518.76 (2090) 57.7319.82 (1999) 0.883 (0.148)
1924 21.731.85 22.131.89 46.5015.85
2539 31.644.58 32.204.25 38.2813.59
4064 51.217.24 50.107.51 42.0611.93
6579 71.384.36 71.744.36 74.169.62
80 83.734.02 83.883.28 73.945.74
Weight (kg) 70.1612.16 (46120) 69.9012.10 (46120) 70.4712.24 (47110) 0.674 (0.421)
1924 73.5012.63 71.8713.99 75.6913.92
2539 69.1313.79 65.8011.74 69.7214.70
4064 71.2312.40 72.0413.79 70.6810.84
6579 71.4611.36 70.7910.56 70.0112.35
80 64.859.69 64.9410.67 70.2511.88
Height (cm) 164.879.26 (130190) 163.979.05 (148189) 165.789.41 (130190) 0.075 (1.784)
1924 173.649.88 171.3810.46 171.758.84
2539 169.369.36 164.808.47 169.249.97
4064 166.638.14 167.348.22 169.448.66
6579 162.748.25 161.438.78 161.427.88
80 157.887.80 159.067.21 164.199.45
BMI (kg/m2) 25.793.73 (16.2642.22) 25.963.64 (17.7242.22) 25.623.83 (16.2638.06) 0.405 (0.834)
1924 24.333.17 24.413.61 25.472.96
2539 23.913.10 24.102.98 24.173.53
4064 25.583.49 25.623.66 24.583.03
6579 26.973.76 27.173.55 26.854.20
80 26.093.96 25.643.48 25.472.96
BDI 7.716.07 (030) 9.596.37 (030) 5.835.11 (024) <0.001 (5.938)
1924 7.366.56 8.257.50 2.751.83
2539 4.324.78 5.445.24 5.365.01
4064 7.175.61 9.146.07 3.903.72
6579 8.626.06 10.676.12 8.215.75
80 11.685.94 13.636.13 4.133.05
Notes: In all the analyses, p<0.01 (with a 99% confidence interval) was considered statistically significant; aindependent t-test.
Abbreviations: BDI, beck depression inventory; BMI, body mass index; LBP, low back pain; SD, standard deviation.

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Calvo-Lobo et al Dovepress

Table 2 BDI by factor with 95% Scheffe intervals

Age Participants n Mean SD Lower Upper Mean Levene test, t-testa
(years) limit limit difference p-value (F) p-value (t)
1924 LBP 8 8.25 7.50 4.44 12.06 3.250 0.150 (2.470) 0.494 (0.713)
No-pain 3 2.65 2.65 0.00 11.21
Total 11 7.36
2539 LBP 25 5.44 5.24 4.10 6.78 1.805 0.823 (0.051) 0.138 (1.504)
No-pain 41 3.63 4.40 2.59 4.68
Total 66 4.32
4064 LBP 50 9.14 6.07 8.11 10.17 4.440 0.001 (11.523) <0.001 (4.244)
No-pain 40 4.70 3.78 3.55 5.85
Total 90 7.17
6579 LBP 67 10.67 6.13 9.70 11.64 4.461 0.174 (1.873) <0.001 (4.375)
No-pain 57 6.21 5.05 5.16 7.26
Total 124 8.62
80 LBP 16 13.63 6.13 11.55 15.70 1.858 0.394 (0.744) 0.094 (1.714)
No-pain 25 10.44 5.59 8.78 12.10
Total 41 11.68
Total LBP 166 9.59 6.37 8.97 10.21 3.765 004 (8.650) <0.001 (5.928)
No-pain 166 5.83 5.11 5.20 6.45
Total 332 7.71
Notes: In all the analyses, p<0.01 (with a 99% confidence interval) was considered statistically significant; aa test of equality of means was performed.
Abbreviations: BDI, beck depression inventory; LBP, low back pain.

bution of participants with LBP and no-pain. Regarding the
overall sample, the BDI scores, as meanSD, demonstrated
statistically significant differences (p<0.001) between partici-
pants with LBP (9.5906.370 points) and no-pain (5.835.11
points), although within normal ranges of depression. Con-
sidering the equality of variances, tests of equality of means
of BDI in the participants with LBP and no-pain for the
overall and age distribution sample are presented in Table 2.
The box plot of BDI in overall participants with LBP and
no-pain is shown in Figure 1A, and according to age distribu-
tion in Figure 1B. ANOVA of the BDI variable with two fac-
tors and interaction (LBP presence and age distribution) was
carried out. The analysis results are presented in Table3. It was
observed that there was no interaction between the two factors
(p=0.5547). Nevertheless, the main effects showed statistically
significant differences of BDI when comparing age distribution
(p<0.0001) or LBP presence (p=0.0002). Figure 1C illustrates
the influence of LBP presence and age distribution on the
mean scores of BDI. The ANOVA model indicated that LBP
influenced the degree of depression, with a partial coefficient
of determination R2=3.43%. Moreover, a partial coefficient of
determination R2=12.19% was associated with age distribution.
Discussion
Despite normal ranges of BDI scores, this study supports
evidence showing higher depression scores in participants
with acute or subacute nonspecific LBP versus asymptom-
atic participants with no-pain, especially in age ranges from
the 4th to 8th decade of their life. Furthermore, anxiety
and depression are frequently present in patients with LBP
attending tertiary care centers.22 The depression scores in
different age ranges of the Spanish population with LBP
and no-pain has not been studied.5 Consequently, this is
the first study to determine the BDI scores in a sample of
participants with nonspecific acute or subacute LBP and
no-pain by age distribution.
Despite the lack of knowledge about the mechanism
and origin of LBP, acute LBP participants seems to be
influenced by selective pain sensitivity enhancement and
differential gene expression profiles with regard to no-pain
participants.23 Neuronal differences have been observed
between depression and LBP.24 The fear avoidance model,
including kinesiophobia and quality of life implications, has
been proposed for patients with depressive symptoms and
LBP.7,8,25 In this sense, this study supports depression as one
of the possible treatment focuses in participants with acute
and subacute LBP.
Therefore, this study establishes that in patients with
nonspecific acute and subacute LBP, there is a relationship
with the BDI depression score. This reflects several studies
that have shown that depression negatively influences LBP
prognosis in the health care system.1,915,22,26

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Dovepress Depression in low back pain by age distribution

A B
30 * 30.00

25 *
25.00 *
*

*
20 * 20.00
*
* *
*

BDI
BDI

15 15.00



10 10.00

5 5.00

0 0.00

No-pain LBP 1924 2539 4064 6579 80

LBP presence Age distribution (years)

C Interactions and 95.0 percent Scheffe intervals

20 LBP
Yes
No
15
BDI

10

0
1924 2539 4064 6579 80
Age distribution (years)
Figure 1 Boxplots of BDI by LBP presence (A), BDI by age distribution (B), and mean of BDI with 95.0% Scheffe intervals by age distribution and LBP presence (C).
Notes: LBP presence (LBP or no-pain group), as well as age distribution of 1924 (young adults), 2539 (middle aged-1), 4064 (middle aged-2), 6579 (aged), and 80 years
were considered. In all the analyses, p<0.01 (with a 99% confidence interval) was considered statistically significant.
Abbreviations: BDI, beck depression inventory; LBP, low back pain.

Table 3 ANOVA analysis of BDI, two factors (LBP presence and subjects, respectively. In addition, the BDI differentiates
age distribution) with interaction depression subtypes.20
Source Sum of Df Variance F-ratio p-value The sociodemographic characteristics of the sample were
squares
homogeneous in order to avoid their influence between LPB
LBP presence 418.17 1 418.17 14.29 0.0002
and no-pain groups. Among patients with LBP, age was
Age distribution 1485.12 4 371.28 12.68 <0.0001
Interaction 88.51 4 22.13 0.76 0.5547 correlated with physical disability and wellness.27 BMI was
Residual 9425.75 322 29.27 shown to be capable of predicting LBP.28 Height and weight
Total (corrected) 12186.70 331 36.82 measures, associated with BMI calculation, may be associ-
Notes: LBP presence (LBP or no-pain group), as well as age distribution of 1924
ated with radiating LBP during the life course.29
(young adults), 2539 (middle aged-1), 4064 (middle aged-2), 6579 (aged), and
80 years were considered. In all the analyses, p<0.01 (with a 99% confidence Several limitations should be considered in this study.
interval) was considered statistically significant.
Abbreviations: ANOVA, analysis of variance; BDI, beck depression inventory;
First, physical factors, such as pain characteristics, recur-
LBP, low back pain; df, degrees of freedom. rence, or physical disability, have not been evaluated.
Despite this, previous studies have shown that depression
The BDI has been widely used and is a valid and reli- may not be influenced by these physical factors.27 Second,
able tool to analyze depression, including in the Spanish younger age ranges, such as children and adolescents, were
population.20,21 The BDIs internal consistency has shown not assessed. Nevertheless, an increased risk to develop spi-
a coefficient alpha of 0.81, as well as 0.60 and 0.74 score nal pain was shown in the most active adolescents.30 Third,
of clinical ratings of BDI and Hamilton Psychiatric Rating chronic LBP was excluded to avoid the central sensitization,
Scale for Depression concurrent validity for nonpsychiatric which occurs in a longer-term process.31 Fourth, the assessor

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133
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Calvo-Lobo et al
was not blinded, although the BDI questionnaire was self-
reported. Although the BDI is a valid and reliable tool and
may be used cross-culturally in Europe, particular caution
should be taken in the Spanish sample. Indeed, regression
analyses demonstrated the inconsistency of the Spanish
sample compared with other European countries in the
relative weight of items 3, 6, 7, 9, 13, 15, and 21.21 Finally,
a more diverse group of individuals and a larger sample size
may improve the study power and help to identify variation
between countries.1
In conclusion, participants with nonspecific acute and
subacute LBP present higher BDI depression scores at certain
age ranges. In particular, those in the age range from 40 to
80years with LBP may require psychological assessment and
care in addition to any medical or physical therapy treatment.
Acknowledgments
The authors did not receive any financial assistance or have
any personal relationships with other people or organizations
that could inappropriately influence (bias) their work.
Author contributions
All authors contributed to concept, design, analyses, interpre-
tation of data, drafting of manuscript or revising it critically
for important intellectual content.
Disclosure
The authors report no conflicts of interest in this work.
References
1. GBD 2013 DALYs and HALE Collaborators, Murray CJ, Barber RM, et
al. Global, regional, and national disability-adjusted life years (DALYs)
for 306 diseases and injuries and healthy life expectancy (HALE) for
188 countries, 19902013: quantifying the epidemiological transition.
Lancet. 2015;386(10009):21452191.
2. Fritz JM, Magel JS, McFadden M, et al. Early physical therapy vs usual
care in patients with recent-onset low back pain: a randomized clinical
trial. JAMA. 2015;314(14):14591467.
3. Dunn KM, Croft PR. Epidemiology and natural history of low back
pain. Eura Medicophys. 2004;40(1):913.
4. Alexopoulos EC, Tanagra D, Konstantinou E, Burdorf A. Musculoskel-
etal disorders in shipyard: prevalence, health care use, and absenteeism.
BMC Musculoskelet Disord. 2006;7:88.
5. Palacios-Cea D, Alonso-Blanco C, Hernndez-Barrera V, et al. Preva-
lence of neck and low back pain in community-dwelling adults in Spain:
an updated population-based national study (2009/10-2011/12). Eur
Spine J. 2015;24(3):482492.
6. Corniola MV, Stienen MN, Joswig H, et al. Correlation of pain, func-
tional impairment, and health-related quality of life with radiological
grading scales of lumbar degenerative disc disease. Acta Neurochir
(Wien). 2016;158(3):499505.
7. Gonzlez-Ramrez C, Montanero-Fernndez J, Peral-Pacheco D. A
multifactorial study on duration of temporal disabilities in Spain. Arch
Environ Occup Health. Epub 2016 Oct 24.
134 submit your manuscript | www.dovepress.com
Dovepress
Dovepress
8. Baird A, Sheffield D. The relationship between pain beliefs and physical
and mental health outcome measures in chronic low back pain: direct
and indirect effects. Healthcare (Basel). 2016;4(3):E58.
9. Seekatz B, Meng K, Bengel J, Faller H. Is there a role of depressive
symptoms in the fear-avoidance model? A structural equation approach.
Psychol Health Med. 2016;21(6):663674.
10. Carley JA, Karp JF, Gentili A, et al. Deconstructing chronic low back
pain in the older adult: step by step evidence and expert-based recom-
mendations for evaluation and treatment: part IV: depression. Pain Med.
2015;16(11):20982108.
11. Valentin GH, Pilegaard MS, Vaegter HB, et al. Prognostic factors for
disability and sick leave in patients with subacute non-malignant pain:
a systematic review of cohort studies. BMJ Open. 2016;6(1):e007616.
12. Pinheiro MB, Ferreira ML, Refshauge K, et al. Symptoms of depression
as a prognostic factor for low back pain: a systematic review. Spine J.
2016;16(1):105116.
13. Wong AY, Samartzis D. Low back pain in older adults the need
for specific outcome and psychometric tools. J Pain Res. 2016;9:
989991.
14. Elfering A, Kser A, Melloh M. Relationship between depressive
symptoms and acute low back pain at first medical consultation, three
and six weeks of primary care. Psychol Health Med. 2014;19(2):
235246.
15. Hirsch O, Strauch K, Held H, et al. Low back pain patient subgroups
in primary care: pain characteristics, psychosocial determinants, and
health care utilization. Clin J Pain. 2014;30(12):10231032.
16. Von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vanden-
broucke JP. The strengthening the reporting of observational studies in
epidemiology (STROBE) statement: guidelines for reporting observa-
tional studies. Ann Intern Med. 2007;147(8):573577.
17. Schenk R, Lawrence H, Lorenzetti J, Marshall W, Whelan G, Zeiss R.
The relationship between Quebec Task Force Classification and outcome
in patients with low back pain treated through mechanical diagnosis
and therapy. J Man Manip Ther. 2016;24(1):2125.
18. Spitzer WO, LeBlanc FE, Dupuis M, ET AL. Scientic approach to
the assessment and management of activity-related spinal disorders: a
monograph for clinicians. Report of the Quebec Task Force on Spinal
Disorders. Spine (Phila Pa 1976). 1987;12(Suppl 7):S1S59.
19. Lpez DL, Callejo Gonzlez L, Iglesias ME, et al. Quality of life impact
related to foot health in a sample of older people with hallux valgus.
Aging Dis. 2016;7(1):4552.
20. Beck AT, Steer RA, Carbin, MG. Psychometric properties of the Beck
Depression Inventory: twenty-five years of evaluation. Clin Psychol
Rev. 1988;8(1):77100.
21. Nuevo R, Dunn G, Dowrick C, et al. Cross-cultural equivalence of the
Beck Depression Inventory: a five-country analysis from the ODIN
study. J Affect Disord. 2009;114(13):156162.
22. Sagheer MA, Khan MF, Sharif S. Association between chronic low back
pain, anxiety and depression in patients at a tertiary care centre. J Pak
Med Assoc. 2013;63(6):688690.
23. Starkweather AR, Ramesh D, Lyon DE, et al. Acute low back pain: dif-
ferential somatosensory function and gene expression compared with
healthy no-pain controls. Clin J Pain. 2016;32(11):933939.
24. Rodriguez-Raecke R, Ihle K, Ritter C, Muhtz C, Otte C, May A. Neuro-
nal differences between chronic low back pain and depression regarding
long-term habituation to pain. Eur J Pain. 2014;18(5):701711.
25. Antunes RS, Macedo BG, Amaral TS, Gomes HA, Pereira LSM, Rocha
FL. Pain, kinesiophobia and quality of life in chronic low back pain and
depression. Acta Ortop Bras. 2013;21(1):2729.
26. Hung CI, Liu CY, Fu TS. Depression: an important factor associated with
disability among patients with chronic low back pain. Int J Psychiatry
Med. 2015;49(3):187198.
27. Billis E, Koutsojannis C, Matzaroglou C, et al. Association of low back
pain on physical, sociodemographic and lifestyle factors across a general
population sample within Greece. J Back Musculoskelet Rehabil. Epub
2016 Sep 23.
Journal of Pain Research 2017:10
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28. Lagersted-Olsen J, Bay H, Jrgensen MB, Holtermann A, Sgaard K.
Low back pain patterns over one year among 842 workers in the DPhacto
study and predictors for chronicity based on repetitive measurements.
BMC Musculoskelet Disord. 2016;17(1):453.
29. Frilander H, Solovieva S, Mutanen P, Pihlajamki H, Helivaara M,
Viikari-Juntura E. Role of overweight and obesity in low back disorders
among men: a longitudinal study with a life course approach. BMJ Open.
2015;5(8):e007805.
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30. Aartun E, Boyle E, Hartvigsen J, et al. The most physically active
Danish adolescents are at increased risk for developing spinal pain: a
two-year prospective cohort study. BMJ Open Sport Exerc Med. 2016;
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31. Nijs J, Apeldoorn A, Hallegraeff H, et al. Low back pain: guidelines
for the clinical classification of predominant neuropathic, nocicep-
tive, or central sensitization pain. Pain Physician. 2015;18(3):
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